to buy a machine or out-source rather than pay an employee. A huge amount of the job loss due to automation in this Country is not because of any inherently better efficiency on the machine’s part but rather because the machine can be expensed off and depreciated whereas the employee is just an ongoing expense. On the assumption that wages would go up if the employer stopped providing health insurance, not a safe assumption in any times and certainly not in these times, you will have just made the employee and the employer liable for all the payroll taxes and employer matches on that additional income. It won’t take long for employers to adapt to that new economic reality.

1- As much as I support tort reform, I just don’t see how my state’s liability laws are the US Government’s business except as they relate to interstate commerce.

2- So once somebody enters my risk pool they can just choose to stay there? I can see some tweaks to COBRA to make it easier for a person to transition from one employer or insurance provider to another, but different employers have different benefit levels, demographics, and risk pools that reflect the company’s hiring and business practices; why should they have to accept some other company’s practices and risks? There’s a lot of difference between the risk associated with sedentary white collar employees and the risk associated with, say, utility linemen or commercial fishermen. See above for my view on pre-tax benefits.

3- I can see removing the bar on sales across state lines, but I have a lot of trouble with the US telling my state what if any mandates we might impose.

4- This is a tough nut. If you cover pre-existing conditions, it isn’t insurance, it’s just assuming a liability. The part I think we need to work on is a person who acquires some condition while insured under some pool but who loses their job or is for some reason forced to change jobs. It makes some sense for the insurer who was covering that person when the condition arose to continue to be liable for treatment of that condition but if the person leaves that employer, treatment of that person will definitely cause the employer’s costs to go up because the employer’s plan will be paying still but no contribution will be made on that employee’s behalf – unless you go back to the notion that a person can stay in a pool indefinitely and the employer should pay indefinitely once a person enters the pool.

5- I’m fine with finding ways for people who don’t have employer provided insurance to purchase insurance with pre-tax dollars though the logistics of it can become complex. I also like removing restrictions on forming pools based on trade associations and other voluntary associations. As to the tax credit on expenses, unless you’ve been involved in plan administration, you can’t conceive of the clever, wierd, and expensive things people can try to get their insurance to pay for or the clever, wierd, and expensive things that docs will try to charge to health insurance, so you’d want to be really careful with that.

6- Alas, the poor will apparently always be with us and this is just one more way to make it more comfortable and even profitable to be poor.